Author: Eric C. Ford, Awusi Kavuma, Solomon Kibudde, Lilie Lin, Apollo Muramuzi, Nibedita Paul, Peniel T Twum, Afua A. Yorke 👨🔬
Affiliation: Uganda Cancer Institute, MD Anderson Cancer Center, University of Washington, Department of Radiation Oncology, Fred Hutchinson Cancer Center, University of Washington, University of Nebraska, Global Communities 🌍
Purpose: Sub-Saharan Africa accounts for over one-third of global cervical cancer deaths, despite representing only 14% of the world’s female population. At the only RT center in Uganda, prior studies show most of the cervical cancer (CxCa) patients do not complete external radiation, and many miss their brachytherapy boost. This study analyzes care gaps to establish a baseline before implementing a mhealth app (GLOCASSA) that we have developed.
Methods: We conducted a retrospective chart review of 51 cervical cancer (CxCa) patients treated between 2023 and 2024 to evaluate the timelines from initial consult to radiotherapy (RT) simulation, treatment duration, end-of-treatment, and follow-up surveillance. For each patient, we calculated the radiotherapy care gap (RCG) factoring in a weighting factor for each stage of the RT process. A score of 1 represented standard care, a score < 1 indicated expedited care, and a score > 1 reflected delayed care.
Results: The age of the patients ranged from 28 to 85 years, all presenting with locally advanced CxCa (IIB-IIIC). The dose schemes used were 45 Gy/15 fx, 50 Gy/ 25 fx and 50.4Gy/28 fx. A geospatial analysis revealed that most patients traveled ~4 hours to access RT care. The EBRT completion time ranged from 28 to 68 days for the 25 fx, 22 to 41 days for the 15 fx, and 35 to 49 for 28 fx regimen respectively. Brachytherapy completion time ranged from 7 to 47 days. The average RCG was 1.20 (range = 0.91 – 2.22) for the 25 fx regimen, 1.34 (range= 0.87 – 3.04) for 15 fx and 1.52 for the 28 fx (range = 1.29 – 1.78).
Conclusion: The RCG score and prolonged durations for patients to complete radiotherapy highlight the necessity for intervention. GLOCASSA has been implemented, and data collection is currently underway. Further data will be available during abstract presentation.